Provider Demographics
NPI:1902971476
Name:ROWAN IV THERAPY INC
Entity Type:Organization
Organization Name:ROWAN IV THERAPY INC
Other - Org Name:OPTIONCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:VAETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-633-5990
Mailing Address - Street 1:1357 W INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3101
Mailing Address - Country:US
Mailing Address - Phone:704-633-5990
Mailing Address - Fax:704-633-6027
Practice Address - Street 1:1357 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3101
Practice Address - Country:US
Practice Address - Phone:704-633-5990
Practice Address - Fax:704-633-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1151251F00000X
NC051733336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251F00000XAgenciesHome Infusion
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0805499Medicaid
NC6800123Medicaid
0307350001Medicare ID - Type Unspecified